Antidepressant

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Management of psychological disorders

• Medical treatment

• Psychotherapy

• Support groups

Depression

• Point prevalence – 5-6 %

• Life time prevalence – 10 %

• Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)

Amine hypothesis of mood

Major depressive disorders results from functional deficiencies of norepinephrine or serotonin

• Most antidepressant drugs enhance the action of NE and serotonin (5-HT)

Drawbacks of amine hypothesis

• Postmortem studies do not reveal any decrease in NE or 5-HT

• Actions within hours effects within weeks

• Bupropion has minimal effects on NE or 5-HT

Antidepressants

• Little difference in efficacy

Choice depends on– Presence of concomitant disease– Existent therapy – Suicidal risk– Response to previous therapy

Depression

• Major depressive episodes (endogenous)

• Tricyclic and SSRIs

• Popularity due to well tolerance

• For severe inpatient – Tricyclic antidepressant

• Electroconvulsion therapy (ECT)

Hyponatraemia and antidepressant therapy

• Hyponatraemia (usually in the elderly and possibly due to inappropriate secretion of antidiuretic hormone) has been associated with all types of antidepressants

• However, it has been reported more frequently with SSRIs than with other antidepressants.

The CSM has advised that hyponatraemia should be considered in all patients who develop

– drowsiness, confusion, or convulsions while taking an antidepressant.

Suicidal behaviour and antidepressant therapy

• The use of antidepressants has been linked with suicidal thoughts and behaviour

• children, young adults, and patients with a history of suicidal behaviour are particularly at risk.

• Where necessary patients should be monitored for suicidal behaviour, self-harm, or hostility,

• Particularly at the beginning of treatment or if the dose is changed.

MAO inhibitors

• Drug interactions

• MAO and tyramine

• Cheese, chicken liver, beer and red wine – Headache – Tachycardia– Nausea – Arrythmia

St John's wort

• Hypericum perforatum

• Unlicensed indication

• Mild depression

• Active ingredient

• Drug interaction

Depression

• Major depressive episodes (endogenous)

• Tricyclic and SSRIs

• Popularity due to well tolerance

• For severe inpatient – Tricyclic antidepressant

• Electroconvulsion therapy (ECT)

Depression

• MAO inhibitors and atypical depression– Labile mood, rejection sensetivity, appetite

disorders

• 4-6 weeks before change treatment

• Drug washout

Panic disorders and phobias

• Antidepressant are generally used

• Imipramine and MAOIs

• SSRIs

• Benzodiazepines

Obsessive-compulsive disorders

• SSRIs are especially effective– Fluoxetine – Fluvaxamine

• Clomipramine – SNRIs

Enuresis

• Tricyclic antidepressant

• Imipramine

• Not preferred approach

Chronic pain

• Tricyclic is clinically useful

• SNRIs– Venalafaxine– Duloxetine

• SSRIs are not effective

Unresponsive patients

5 Ds

Diagnosis

Drug

Dose

Duration of treatment

Different treatment